Versant Health · 1 day ago
Provider Data Specialist_NO
Troy, NY
Full-time
Onsite
Mid, Senior Level
$20/hr - $22.50/hr
4+ years expVersant Health is one of the nation’s leading administrators of managed vision care, serving millions of clients nationwide. The Provider Data Specialist role is responsible for managing and maintaining the accuracy of provider data across multiple databases, ensuring compliance with regulations, and supporting internal departments with provider education and data integrity initiatives.
EyewearHealth CareInsurance
Responsibilities
Directly responsible for creating newly contracted providers, their offices, and payee(s), into the three (3) provider databases based on data received via contracting, credentialing reports, and direct provider submissions
Directly responsible for creating new non-contracted providers, their offices, and payee(s), into the three (3) provider databases; comprehensively reviews and edits existing non-contracted provider data to facilitate accurate claims processing and the issuance of authorizations
Directly responsible to comprehensively reviewing, editing, updating existing provider, office, and payee records as needed and as requested. Requires review of documentation and reports, as well as acting on requests from internal and external customers
Directly responsible to terminate provider, office, and payee records as requested using correct termination reason codes to determine controllable and noncontrollable terminations. Requires extensive review of documentation and reports, as well as acting on requests from internal and external customers
Manage complex Retailer and Provider Group data by periodically receiving and comprehensively reviewing the provider databases and rosters and performing updates to the three (3) provider databases
Directly responsible for managing “Provider Pick” and “Provider Contract” claims pend queue and providing guidance to Claims on claims processing
Maintain IRS standards for Payees and utilize Tax Identification Number verifications
Annually, resolve all 1099-B submissions to Versant Health
Support Versant Health Accounts Receivable Department with provider education on Negative Balance accounts and network suspension and reactivations
Educate and assist Providers and their office personnel with understanding the uses, importance, and impact of their provider data to Members and the Provider Directory
Educate and assist all Versant Health departments with provider data, Provider Directory questions, and various data integrity projects
Review and process Provider Directory data updates received from contracted Provider Directory & Outreach vendors to ensure data accuracy; perform updates, corrections, and terminations of provider and office data
Initiate and/or support provider database improvements and communication processes as needed with other departments regarding database enhancements
Contact assigned providers to validate required data elements via phone and/or email
Conduct peer review audits and provide feedback to reduce errors and improve processes and performance, maintaining current provider data to ensure the quality of the network, and may be responsible for representing the provider network area on department related IT projects
Qualification
Required
Four to Five (4-5) years of experience with a managed care organization in a Provider Data Management, Credentialing, Network Management, Network Development, and/or Provider Relations role
Combination of education and work experience required
Capable and comfortable dealing with Protected Health Information (PHI), Personal Identifiable Information (PII), sensitive, and confidential information with discretion and trust
Experience must include direct responsibility for managing provider, office and payee data and/or claims processing
Experience working with provider networks and healthcare providers
Knowledge and experience in CMS Provider Directory regulations
Proficiency in Microsoft Office Excel, Word, Excel, Access, and Power Point
Preferred
Associate or Bachelor's degree preferred
Benefits
Health and dental insurance
Tuition reimbursement
401(k) with company match
Pet insurance
No-cost-to-you vision insurance for you and your qualified dependents
Company
Versant Health
Versant Health offers eye health and vision care plan for members, clients, brokers, and eye care professionals.
1001-5000 employees
H1B Sponsorship
Versant Health has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (2)
2024 (3)
2023 (2)
2022 (6)
2021 (2)
2020 (5)
Funding
Current Stage
Late StageTotal Funding
unknown2020-09-17Acquired
Leadership Team
Kia Lindsay
Chief People Officer
Neelam Gor
Chief Clinical Officer
Recent News
2022-04-28
Company data provided by crunchbase